Sex-bias case has lessons for the medical profession

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THERE IS little doubt that Dr. Josef Fischer was a top-notch surgeon. He helped transform a city-owned indigent-care hospital in Cincinnati into an academic medical center. He expanded a 10-member surgery department at the University of Cincinnati into a top training site, with a faculty of more than 60. He made such a mark that there is still an award in his name “for excellence in patient care, attention to detail, and intellectual curiosity in the pursuit of clinical and scientific knowledge.”

But it is also clear that Fischer had an abrasive personality. Even his greatest admirers describe him as difficult. He was known for pushing out colleagues he didn’t like. Over his 23-year career in Cincinnati, he was named in lawsuits alleging age discrimination, filed by a 60-year-old director of the Division of Neurosurgery; disability discrimination, filed by the executive director of an organ transplant center who took leave for a mental illness; and sex discrimination, filed by a female dental assistant who accused a dentist working under Fischer of harassing her and retaliating against her when she complained. (Only one suit — the sex discrimination case — prevailed.)

Fischer went on to become the head of surgery at Beth Israel Deaconess Medical Center in Boston, a Harvard teaching hospital, where he is credited with putting the institution on firmer financial footing. Unfortunately, he brought his personality with him. Today, he is the central figure behind the hospital’s $7 million settlement with the female former chief of anesthesia, who says he tried to ruin her career because she is a woman. Dr. Carol Warfield’s claims, which were backed up by testimony from senior female surgeons, illustrate the dark side of superstar surgeons like Fischer. Historically, the most celebrated surgeons were swashbuckling men who could make snap judgments and act on them without fear of the consequences — traits that may have contributed to Fischer’s lack of concern for his colleagues’ feelings.

But there’s a bright line between a brusque, dismissive attitude and the kind of broad-brush intolerance that Fischer has been accused of showing. According to Warfield’s lawsuit, he openly stated that women shouldn’t be surgeons. Fischer, 75, may have gotten away with such sexist bombast when he graduated from medical school back in 1961. Today, that attitude is a lawsuit waiting to happen. Although Fischer has retired from his position at Beth Israel Deaconess, he still attends weekly sessions to discuss patient cases and is still a professor at Harvard Medical School. Both institutions should make it clear to him that if he wants to teach medicine in the 21st century, he must abide by 21st-century norms.

Warfield’s lawsuit also suggests that the profession itself needs some soul-searching. According to anthropologist Pearl Katz, the culture of surgery evolved over centuries of battlefield amputations. Like soldiers, good surgeons were expected to make quick decisions, project unwavering self-confidence, and exhibit stoicism in the face of a patient’s pain. Today we know that some of those traits — traditionally viewed as masculine — actually increase the risk of medical mistakes. Medicine has changed. Today’s surgeons, male and female, should change with it.